You’re in the middle of a disaster or on a long hike, and suddenly you feel a little faint. Or maybe you feel butterflies in your chest.

You check your pulse, and it’s going really fast. Since your pulse is an extension of your heart, that means you have a really fast heart rate also. What do you do?

Until you can get medical help:

1. Sit down if you can.

2. Check your pulse rate. (See the “Check Your Normal” insert below.) If it’s going at a speed of 100–110, and it’s at a regular rate (maybe a few skips) you could be just overtired or nervous. Sit or lie there for a few minutes and try to relax. Dehydration, fever, and anemia can cause the heart to beat fast like this also.

But …

If the heart rate is closer to 150 or higher, you’re probably in what we call supraventricular tachycardia (SVT). In SVT, your heart’s electrical system, which controls the heart rate, gets out of kilter. (See the insert about the electrical system below.) This can result in two things.

First, when the rate’s that fast, the heart can’t efficiently empty the blood from its chambers. Second, those chambers’ pumping rhythms can get out of sync. (Normally your atria pump blood to your ventricles, which pump it out milliseconds later. You can hear that when you listen through a stethoscope. Tadump, tadump. That system can get out of whack in SVT.)

The Heart’s Electrical System

Normally the heart rate is triggered at the “sinus,” or “sinoatrial,” node (1). The impulse then travels through the heart, syncing the beats of the four chambers (atria and ventricles). The sinus node knows when to speed up or slow down the rate if it thinks the body needs more or less blood to furnish its needs.

Sometimes, for various reasons, the “supraventricular node” (2) can take over. It will trigger the heart to beat around 150 times per minute (supraventricular tachycardia—SVT). This is an abnormal rate and always too fast.

Occasionally, the left ventricle (7) can take over the rate at around 300 beats per minute (ventricular tachycardia—VT). That rate is unsustainable for life. If VT happens, you can try a hard thump with your fist to the middle of the chest, or hope the vagal maneuvers work. Neither method works very often, and if you can’t make it to a medical facility quickly, you’re likely not to survive.

(Ignore the other numbers in the picture for our purposes.)

Any of this is a big stress on the heart. Your blood pressure may drop because your heart isn’t pumping blood out as efficiently. If you have underlying heart disease you could have a heart attack.

Get The Survival Doctor’s interactive guidebooks here. They do an anxious heart good.

3. If you think it’s SVT, get your heart rate down.Until you can get medical help there are a few things you can try to kick it back into a normal, safer, more-efficient rate. All of these stimulate your vagus nerve (which has direct connections to your heart) and help control the rhythm. After each “vagal maneuver,” check the pulse to see if your heart rate has slowed.

a. Valsalva maneuver.
Hold your breath and bear down in a strain (like if you’re constipated and straining to have a bowel movement). Do this for five seconds, then breathe. This changes the pressure in your chest and therefore in the big blood vessels in it. That fools your body into thinking your heart should slow down. If the pulse hasn’t slowed, try again. Another way to do the Valsalva maneuver is to stick a finger in your throat and gag yourself.

b. Carotid maneuver.
Find your carotid pulse (see top photo) just below your jaw. The vagus nerve runs next to it. Massage very firmly for five seconds. Warning: In rare cases this could knock off a piece of a blood clot lodged in this area and cause a stroke. Don’t do this in elderly people or anyone with a history of a stroke.

c. Ice-water facial.
A little odd, I know, but if you have cold water (preferably ice water,) dip your face in it a few seconds. This stimulates your vagus nerve to slow your heart by causing what’s known as the dive reflex. It’s the same reflex that helps some people survive for a long time under cold water by slowing the body’s metabolism down.

Whether or not one of these things works, or your heart rate converts back to normal on its own, get checked by a doc as soon as you can. SVT can also be prevented with prescriptions medicines.

Has anyone ever experienced a fast heart rate? What did you or the medical personnel do? How was it treated, or did it just go away?

This is where you find the radial pulse. Always use two fingers to feel for a pulse. It helps you make sure you’re not mistaking your own pulse in your finger for someone else’s.

Check Your Normal

Go ahead and check your pulse now. Yes, right now. If you know where to find it and what a normal pulse feels like, it’s going to be lot easier to check it when it’s abnormal. See the photos (right and top) to locate two of the most common areas.

Notice the regular rhythm, speed, and force of your normal pulse. If you have a watch, count the rate for ten seconds and multiply times six for the heart rate per minute. Or check the rate for fifteen seconds and multiply times four. The normal rate is 60–100 beats per minute. Some athletes may have slower normal rates because their heart pumps blood so efficiently.

Then check your pulse without counting to get a feel of what a normal rate is so that if you don’t have a watch when you need it, you can discern when it’s beating way too fast.

Carotid artery photo by Shannan Muskopf on Flickr. Illustration of the heart’s electrical system by J. Heuser, based on an illustration by Patrick J. Lynch, illustrator, and C. Carl Jaffe, MD, cardiologist, Yale University Center for Advanced Instructional Media. The illustration (only) is licensed under the Creative Commons Attribution 2.5 Generic license.

Late to this discussion, but since I am reading this 2 years on, I assume others will too. Years ago I had a few episodes of tachycardia (> 200 bpm) that happened while mountain climbing, probably brought on by a mix of mild dehydration, high altitude effects, and overexertion. After a thorough exam found nothing suspicious, my doc taught me the Valsalva (which can also be done sitting or lying down), and also suggested a sudden exhalation when releasing the “crunch”. Worked like a charm.

http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

Thanks, Joebco

shell

wow, glad to see additional techniques to slow the heart. Last night my episode lasted 2 hours, peaked at 209, settled in the 185 range and nothing I did worked. (bearing down, pressing eyeballs, breathing) When I went to the cardiologist, they did all kinds of test but could not identify a cause for my rapid heart rate and said my heart was healthy. The episodes are getting more frequent (they used to come a couple times a year, lately every 3-5 weeks) and I’m getting more concerned as I am out of the country serving as a caregiver for my elderly parents.

If you have no health reasons not to, then regular exercise should bring it down. Limit caffeine and don’t take cold medicines. If you get up to say 3 miles of brisk walking a day and it’s not coming down then, perhaps your doctor should look for other reasons.

perry

I have high BP, SVT, arthritis, I take meloxicam15mg, and metoprolol 100mg, and hydrochlorothiazide25mg, anything better than this med, meloxicam can cause high BP, and fast heart rate, I had trup for BPH prostate 6 months ago and still have pain, can you tell me something better or natural med.

http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

I assume that the blood work including a thyroid test has been done to rule out reasons for the fast heart rate. And, as you probably know, the metoprolol will treat the fast heart rate and blood pressure both. If you’re concerned about the meloxicam, I would ask your doctor about leaving it off for a week or two and see what it does to your blood pressure and pulse by getting an automatic blood pressure machine to check those at home. In general, the supplements glucosamine and chondroitin may help arthritis, but be sure to read up on interactions and side effects. Non medication methods that have been shown to help some people include, acupuncture, tai chi, and massage. Not being overweight is a must for arthritis of the knees and ankles. Normal weight can also help lower blood pressure as can regular exercise such as walking, swimming, water aerobics, etc. but check with your doctor before beginning on a vigorous program. Calcium, magnesium, vitamin D, coenzyme Q10, fish oil, and garlic might helps some. There’s also this http://www.thesurvivaldoctor.com/2013/02/14/what-to-do-to-lower-blood-pressure/

GMoon

Hello i’m a 31 year old female..just diagnosed with Hashimotos and also have 4 goiters on my thyroid. Even though I have Hashimotos (which is hypothyroid) I get a lot of the hyperthyroid symptoms.Also, my blood tests actually show my thyroid working normally..levels are within range. My question is, for the last month or so, I wake in the middle of the night with a pounding heart, and sometimes feeling like i’m breathing fast. I have noticed that propping my pillow once I wake does seem to slow my heart down. I’ve had a million EKG’s, stress test, 2 week holter monitor, x-rays of my heart and lungs, etc..all the cardiologist said was that I have “normal fast heart beats” and prescribed a 25mg Beta blocker..i’ve taken one during these middle of the night episodes, and they don’t help them. My heart doesn’t slow back down until I get up for the day. What could be causing this? Could the goiter be hitting something and causing this fast heart beat while sleeping? My doctor thinks it’s gerd and my cardiologist just kind of shrugged it off. Any advice please?

http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

The first thing that comes to mind is are you sure you’re following the directions taking the beta blocker. Usually that would be taken on a regular basis and not as needed since it would not start acting immediately. Secondly, are you following a good treatment for gerd with an an acid reducer, making sure your evening meal is small, no evening alcohol, and no eating before bedtime. if you’ve done those things and still having trouble, perhaps ask your doctors if they think a referral to a sleep specialist and a sleep lab study would be useful, or if they thing anxiety and panic attacks could be the culprit.

GMoon

Hello..I really appreciate the response back. For about the last week I have been taking the beta blocker daily, also I just started on a prescription acid reducer..but I am still waking with these episodes. I also wake with my mouth VERY dry during the night now. Sometimes I wake with the feeling like i’m breathing too fast or too much..hard to explain. I don’t snore though, and do not wake gasping for air..so I didn’t really think this was a sleep apnea thing. I do seem to always have very slight constant sniffles though. My primary seems to just dismiss everything I have as anxiety- because I do have an anxiety issue, but I do not feel like this is just anxiety. To me, this all seemed to start right before my doctor felt the goiters on my thyroid. I’m just confused as to where to go from here with this! Any help is very much appreciated!!

http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

1. Consider seeing an ENT doctor to evaluate the goiter.
2. Consider seeing a sleep specialist.
3. Remember relaxation techniques, exercise, decreased caffeine to make sure you are doing everything you can for the anxiety aspect.

Jes

I’m joining the navy, but when I got my physical my pulse was 117 so they disqualify me and told me to go to the navy reserve to check my pulse again, funny because when I’m in my house, store, with friends my pulse is about 80-90 and every time I go to the base to check the pulse it goes up to 110 -100

http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

Some people’s blood pressure goes up only when they’re at the doctor’s office. The same thing could happen with the pulse. However, perhaps you should see a doctor and make sure nothing’s wrong. If not, you could try getting more exercise (which brings the pulse down) and try relaxation and breathing techniques to use when you’re getting it checked on the base.

Hi Doc, thanks for this site. My wife’s heart rate was 171 for over an hour. I came upon your website and used your method and it worked. Thanks very much once again.

http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

Jacques, that’s great. But, still, she needs to have a good checkup.

Jacques

We will definitely do that, thanks.

Dustin

Good Afternoon,

Thank you for the tips. I sometimes at work will get a heart rate of 100-120 and very little i do can lower it…when I’m at home i can normally bring it down to around 75-85. my normal is right around 80. Sometimes even when I do these tricks (cant do the ice water thing as im at work) my heart rate increases (especially during the holding your breath one). Any advice?

http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

In general, a heart rate in the 100-120 range could just be normal reaction to strenuous exercise. It would be sinus tachycardia and wouldn’t be slowed by anything (and shouldn’t) other than rest. On the other hand, having a heart rate above 100 and fully rested, could mean something like anemia, thyroid problems, anxiety, medications, and many other things, and would need to be checked out, find the reason, and treat the reason. Sinus tachycardia won’t respond to vagal maneuvers including ice water.